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Research into diagnosing breast cancer

All tests for cancer must be fully researched before they can be adopted as standard. This is so that we can be sure they work better than approaches we already use. It also helps to make sure that they are safe and don’t have harmful effects.

A lot of research is looking into finding better ways of diagnosing breast cancer. Trials and studies are checking new blood tests, different types of mammograms, and scans.

Cancer Research UK supports a lot of UK laboratory research into cancer and also supports many UK and international clinical trials.

Diagnosing breast cancer

There is a lot of research into diagnosing breast cancer. Cancer Research UK supports a lot of UK and international clinical trials. You can find detailed information about breast cancer trials on our clinical trials database.

The UK breast cancer screening programme plays a big part in picking up cancers early. The screening service includes women between the ages of 50 and 70 in the UK. This is being expanded from 47 to 73 years. If you are between these ages, you automatically receive an invitation to go for breast screening every 3 years. Research is looking at newer and more accurate tests for picking up breast cancer in women with no symptoms (screening) and in women who have suspicious symptoms.

Breast screening in younger women

Usually women don’t enter the UK breast screening programme until the age of 47. But women with a strong family history of breast cancer may start having mammograms earlier and more often.

The FH-01 trial looked into yearly screening for women between 40 and 49 who were thought to be at high risk of breast cancer. It found that the yearly mammograms found cancers at an earlier stage and helped to save lives.

The FH-02 trial is looking at whether yearly mammograms can help save the lives of women aged 35 to 39 who are at an increased risk of breast cancer. The trial has closed and we are waiting for the results.

Extra tests during breast cancer screening

Studies are looking at measuring each woman's risk of breast cancer and whether extra tests are helpful in breast screening.

Finding each woman's risk of breast cancer

The PROCAS study is collecting information from women taking part in the NHS breast screening programme in Greater Manchester. The chance of getting breast cancer is not the same for all women. Some have a higher risk and some have a much lower risk.

As well as having mammograms, women taking part also answer questions about their family history and give a sample of spit (saliva). Researchers in this study hope to be able to accurately work out each woman’s risk of breast cancer. Then in the future each woman could be given appropriate advice on how to reduce their risk. Women at higher risk could perhaps be offered screening more often.

Blood tests

Some women who are screened for breast cancer using breast X-rays (mammograms) are called back for further tests. This can be very worrying, but most of them will turn out not to have cancer.

Doctors are trying to develop a new blood test to use in breast screening so that fewer women are called back unnecessarily. Some studies are checking for particular proteins or other substances in the blood of women called back after abnormalities are found on their mammogram.

The immune system and breast cancer screening

Doctors want to find out whether there are changes in the immune system in women with early breast cancer. If there are immune system reactions that could be picked up somehow, they may help doctors find breast cancer at an earlier stage.

There is a research study looking for antibodies and white blood cells called T cells in women with or without breast cancer. Antibodies and white blood cells are part of the immune system. The main aim of this study is to find new signs (markers) in the blood of women with breast cancer. The markers could one day be tested to help doctors screen for and diagnose breast cancer. The trial has closed and we are waiting for the results.

Screening breast ducts

This is called nipple aspiration. The nipple aspiration test gets samples of breast fluid from the milk ducts. The fluid in the tubes of the breast (the ducts) is in direct contact with the cells lining the breast ducts and lobules. This lining is a common area for breast cancer to develop. The doctor or nurse takes fluid from the nipple using a similar pump to the one used to express milk when breast feeding.

Doctors call this intraductal lavage. The doctor puts some anaesthetic on your nipple and then puts a very thin tube into one of the milk ducts of the breast. They put some saline (salt water) fluid into the tube and then take it out again with a syringe. The fluid washes around the duct and contains some of the cells that line the ducts.

Doctors call this duct endoscopy. The doctor puts some anaesthetic cream on your nipple and then puts a very fine flexible tube with a light and magnifying lens into a breast duct. The doctor can look at the cells and also take samples of fluid. Trials are looking into how reliable these types of intraductal screening might be in picking up DCIS or breast cancer or whether it could help to decide a woman's risk of developing breast cancer in the future.

Using computers to read mammograms

Most mammograms in the NHS breast screening programme are checked by two specialists. It is more accurate if there are two professional opinions instead of one. But there is a great deal of strain on the system and this will increase as the age range of women taking part increases from 47 to 73.

Researchers have looked at using a computerised reader system called computer aided detection (CAD). The CADET 2 trial used CAD and one specialist to read mammograms for more than 28,000 women. It found that it is as accurate as using two specialists.

Now the NHS breast screening programme is looking at how CAD can be used as part of the screening programme in the UK.

3D mammograms

Doctors call this digital breast tomosynthesis or 3D mammography. It is a new way of taking X-rays. A scanner produces a series of X-rays at different angles over a 30 degree arc. From these, a computer creates a 3D image of the breast. This gives more information about the breast tissue and a clearer picture.

Some UK hospitals are trying 3D mammograms. The aim of the TOMMY trial is to compare the accuracy of 3D and standard mammograms when diagnosing breast changes found during screening. The trial has closed and we are waiting for the results.

One study is for screening young women with a high risk of breast cancer. Researchers want to see if 3D mammograms can reduce the need for other tests to confirm (or rule out) a diagnosis of cancer. We have information about the tomosynthesis for screening young women trial.

Heat scans (thermography)

Thermography is also called digital infrared imaging. Some people call it a thermal scan. The 3 parts to the theory behind it are that

The area around a cancer is warmer than the surrounding breast tissue

Cancer cells are more active than normal cells and produce more heat

Hotter areas can be seen on a scanner showing differences in temperature

In 2012, researchers pulled together all the research that has been done on heat scans. This is called a systematic review. They found that there is not enough evidence to show that thermography is reliable enough as a screening test for breast cancer. There is not enough evidence that it can help to diagnose breast cancer when used with mammograms in screening. And there is not enough evidence that it can help to diagnose breast cancer when there are signs that a breast cancer might be there.

Until we have research evidence to show it is reliable, thermography is not recommended as a screening test or to try and diagnose breast cancer.

The COMICE trial added MRI to the standard breast cancer diagnosis tests – mammogram, biopsy and breast ultrasound. The researchers wanted to see whether adding MRI could show the size of the tumour more accurately. They hoped that it would reduce the number of women who need further operations after their surgery.

The researchers found that adding MRI did not reduce the number of women needing further operations. So, they recommended that MRI is not added to routine diagnostic testing for women with invasive ductal breast cancer. But MRI can often accurately show the size of the cancer for women with invasive lobular cancer. So it is usually used for these women when planning surgery. It is also helpful if women have had breast implants.

Fusion scans combine MRI and ultrasound. Researchers are looking at whether they may be able to show areas of breast cancer more clearly than MRI on its own. These scans are only used as part of research trials.

With a PEM scan you first have an injection of a very small amount of a radioactive drug (tracer). The amount of radiation is very small – no more than you have during a normal X-ray. It only stays in the body for a few hours. The drug is taken up by cancer cells but also areas of inflammation. Doctors think that it may be very helpful in finding areas of ductal carcinoma in situ (DCIS).

The MARIA scan

MARIA is short for Multistatic Array processing for Radio wave Image Acquisition. It uses radio waves to look for tumours in the breast and produces 3D (3 dimensional) images. Mammograms use X-rays and produce a 2D picture. MARIA picks out tumours because they have a different thickness to normal breast tissue. The test is at the early stages of development and is only available as part of clinical trials.

To have the test, you need to undress to the waist and lie face down on a special couch. The couch has two cups which you put your breasts in. The cups each have 16 antennae on the outside which send sound waves through your breast tissue. The antennae feed the information into a computer which makes the 3D picture and highlights any possible tumours.

In trials so far, women who had the test had no side effects. And they found the test more comfortable than a mammogram because the breast doesn’t need to be compressed. MARIA also uses sound waves rather than X-rays so it doesn’t expose the breast to any of the possible risks linked to radiation. Early trials with MARIA have given promising results. But the test will only become available if other trials show that it is as good as, or better than standard screening using mammograms. It takes some time for the results of these trials to become available. So it will be a couple of years before we know if it is a reliable screening test for breast cancer.

Using light (optical biopsy)

Scientists are investigating a new test which uses light to find cancer cells in breast tissue. This is done either during a biopsy, or on breast tissue removed when you have surgery. The test is called elastic scattering spectroscopy (ESS). Doctors hope that they will be able to use this test directly on the breast to diagnose cancer much quicker.

Using radio waves to biopsy

This is a new type of breast lump biopsy being researched. Doctors call it image guided radiofrequency biopsy. It aims to take a biopsy of an abnormal area of the breast through a small cut. Doctors carry it out under local anaesthetic. Using X-ray or ultrasound guidance they put a small probe close to the abnormal area. The probe cuts using radio waves and removes the tissue. A small cage attached to the probe holds the tissue. This way of doing a biopsy aims to cause less bleeding and swelling than a normal biopsy.

NICE recommends that this procedure should only be used to remove cancer that has been diagnosed using other tests and there are no other surgical options. They also ask for more research to be carried out into image guided radiofrequency biopsy of breast lumps.

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